The opening salvo in the Republicans’ bid to replace the Affordable Care Act was fired this week, setting up a potentially long battle and leaving South Carolina leaders scrambling to figure out how the proposal would affect the Palmetto State.

One thing is for certain: the industry does not like uncertainty.

“Transition is very important” to the insurance field, said Jim Ritchie, executive director of the S.C. Alliance of Health Plans and a former Republican state lawmaker.

“We want to make sure it’s stable and predictable,” he added.

To that end, S.C. Department of Insurance Director Ray Farmer said his staff is busy reviewing the finer details of the proposal, which was released late Monday.

Farmer said the replacement would preserve some of the Affordable Care Act’s popular provisions, including the rule that allows young adults to remain on their parents’ insurance plans until they turn 26. He wasn’t up to speed on other aspects of the bill.

“I just need to get into the weeds and take a look at what other parts of the proposal are,” he said.

‘Tug-of-war’

U.S. Rep. Mark Sanford, R-S.C., who introduced his own Obamacare replacement bill last month that was endorsed by the conservative House Freedom Caucus, didn’t slam the new bill outright.

“The tug-of-war has begun,” Sanford told The Post and Courier on Tuesday.

“I look forward to learning more,” Sanford continued. “I want to be respectful to leadership with regards to the difficult task they have in terms of trying to get consensus.”

But Sanford questioned why House Republican leaders would not support a repeal bill that’s as ideologically conservative as the measure both chambers of Congress were able to advance two years ago when President Barack Obama had no intention of repealing his signature legislative accomplishment.

“I think the bill Republicans sent to a Democratic president was good enough,” Sanford said of 2015. “And I don’t understand why it wouldn’t be good enough to send to a Republican, as well.”

The House Freedom Caucus recently took a vote to oppose — as a bloc — any bill that doesn’t meet the same standards as the 2015 bill.

President Donald Trump said Tuesday he was proud to support the bill introduced this week and hopes it will pass quickly.

U.S. Sen. Tim Scott, R-S.C., who sits on two Senate committees with jurisdiction over health care legislation, said he had not studied the House Republicans’ proposal.

He cautioned his colleagues, however, against drawing lines in the sand.

“Already some are saying they will not be moving forward unless there is ‘fill-in-the-blank,’ ” Scott said. “So we are starting to paint ourselves into a very small space in order to get this done.”

Scott said his only requirement at the moment is that the Obamacare repeal bill makes it so that “buying health insurance is no longer compulsory.”

The replacement element, he said, is what “we’re all going to fight about.”

Improving Obamacare

Farmer, the Insurance Department director and a member of Gov. Henry McMaster’s Cabinet, said he believes the replacement bill released this week marks an improvement over the existing law.

“I’m coming from the position that Obamacare didn’t work,” Farmer said. “There’s example after example in our state where it just didn’t work.”

Premiums are more expensive than they were several years ago, he said, and fewer companies are selling health insurance in South Carolina. Many patients also face narrower provider networks, he said.

“My goal is to have increased competition in the state and Obamacare did not do that – quite the reverse,” Farmer said.

Companies that intend to sell health insurance plans in South Carolina next year through the federal marketplace or directly to customers “off the exchange” must submit their proposed plans and rates by late spring, Farmer said.

“That is my concern, as well,” he added. “There have been no new companies beating the door down.”

Industry concerns

Some aspects of the existing health care law wouldn’t change at all, including the provisions that forbid insurance companies from denying coverage to patients with pre-existing conditions or from setting annual or lifetime spending caps.

Notably, though, the replacement bill would eliminate the “individual mandate,” which requires nearly everyone to obtain health insurance or pay a fine for failing to do so.

More than 200,000 South Carolinians are currently covered by insurance plans purchased through the Affordable Care Act marketplace. BlueCross BlueShield of South Carolina is the only company offering coverage through the exchange this year and a spokeswoman for the insurance company said, at least for now, it’s business as usual.

The company will study the proposed replacement bill, she said, and looks forward to “sharing information with lawmakers as they work through the process.”

Other experts were less optimistic about the proposal.

Frank Knapp, president of the S.C. Small Business Chamber of Commerce, said the plan will likely insure fewer people and could have a “dramatic impact on the economy.”

Schipp Ames, a spokesman for the S.C. Hospital Association, said his group is specifically worried about a proposed Medicaid funding cap, and about increased costs for seniors and “other vulnerable populations.”

A spokeswoman for the South Carolina Medicaid agency said Director Christian Soura hadn’t seen the replacement bill and therefore couldn’t talk about it.

Dr. Pat Cawley, CEO of Medical University Hospital, also expressed concern that the proposal would insure fewer patients but said it is hard to speculate on the impact of the bill until the Congressional Budget Office scores it to determine how much it will cost and how many people it will likely insure.

“At this point, we’re all guessing,” Cawley said. “Until you actually attach numbers to each of these policies, it’s hard to determine.”

Ames agreed that it is “premature to judge whether it makes sense for South Carolina.”